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This form will be generated automatically by ACF with all information submitted for the record by the participating State. This is an example of only one page. A report is generated for both Adoption and Foster Care.
Foster Care Case Review Report |
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AFCARS Element |
Data from AFCARS |
Data from Paper File |
Data Do Not Match (X) |
#3 Local FIPS Code |
Clinton |
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#5 Date of Most Recent Periodic Review |
July 08, 2002 |
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#6 Child Birth Date |
August 22, 1988 |
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#7 Child Sex |
Male |
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#8 Child Race |
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a. American Indian/Alaska Native |
No |
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b. Asian |
No |
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c. Black/African American |
No |
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d. Hawaiian/Pacific Islander |
No |
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e. White |
Yes |
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f. Unable to determine |
No |
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#9 Child Hispanic Origin |
Yes |
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#10 Has Child Been Diagnosed with Disability? |
No |
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#11 Mental Retardation |
Condition does not apply |
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#12 Visually/Hearing Impaired |
Condition does not apply |
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#13 Physically Disabled |
Condition does not apply |
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#14 Emotionally Disturbed |
Condition does not apply |
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#15 Other Diagnosed Condition |
Condition does not apply |
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#16 Has Child Ever Been Adopted |
No |
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#17 Age at Adoption |
Not Applicable |
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#18 Date of First Removal from Home |
April 10, 2000 |
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#19 Total Number of Removals from Home |
01 |
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#20 Date of Discharge from Last Episode |
- |
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#21 Date of Latest Removal |
April 10, 2000 |
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#23 Date of Placement in Current Setting |
October 24, 2002 |
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#24 Number of Previous Placement Settings in Episode |
07 |
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#25 Manner of Removal from Home |
Court Ordered |
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#26 Condition Associated with Removal - Physical Abuse |
Condition Applies |
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#27 Sexual Abuse |
Condition Applies |
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#28 Neglect |
Condition Applies |
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#29 Parent Alcohol Abuse |
Condition Applies |
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#30 Parent Drug Abuse |
Condition Applies |
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#31 Child Alcohol Abuse |
Condition Does not Apply |
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#32 Child Drug Abuse |
Condition Does not Apply |
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#33 Child Disability |
Condition Does not Apply |
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#34 Child's Behavior Problem |
Condition Applies |
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#25 Death of Parent |
Condition Does not Apply |
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#36 Incarceration of Parent |
Condition Applies |
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#37 Caretaker Inability to Cope Due to Illness or Other Reasons |
Condition Applies |
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#38 Abandonment |
Condition Does not Apply |
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#39 Relinquishment |
Condition Does not Apply |
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#40 Inadequate Housing |
Condition Applies |
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#41 Current Placement Setting |
Foster Family Home (non-relative) |
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#42 Is Current Placement Out-of-State? |
No |
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#43 Most recent case plan goal |
Adoption |
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#44 Caretaker Family Structure |
Single Female |
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#45 1 st Primary Caretaker's Birth Year |
1971 |
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#46 2 nd Primary Caretaker's Birth Year (if applicable) |
- |
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#47 Mother's Date of TPR |
April 23, 2002 |
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#48 Legal or Putative Father' TPR |
January 30, 2002 |
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#49 Foster Family Structure |
Single Female |
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#50 1 st Foster Caretaker's Birth Year |
1972 |
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#51 2 nd Foster Caretaker's Birth Year |
- |
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#52 1 st Foster Caretaker's Race |
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a. American Indian/Alaska Native |
No |
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b. Asian |
No |
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c. Black/African American |
No |
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d. Hawaiian/Pacific Islander |
No |
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e. White |
Yes |
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f. Unable to determine |
No |
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#53 1 st Foster Caretaker's Hispanic or Latino Origin |
Yes |
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#54 2 nd Foster Caretaker's Race (if applicable) |
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a. American Indian/Alaska Native |
- |
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b. Asian |
- |
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c. Black/African American |
- |
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d. Hawaiian/Pacific Islander |
- |
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e. White |
- |
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f. Unable to determine |
- |
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#55 2 nd Foster Caretaker's Hispanic Origin |
- |
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#56 Date of Discharge from foster care |
- |
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#58 Reason for Discharge [These are not listed on the form] 1 = Reunification with Parent(s) or Primary Caretaker(s) 2 = Living with Other Relative(s) 3 = Adoption 4 = Emancipation 5 = Guardianship 6 = Transfer to Another Agency 7 = Runaway 8 = Death of Child |
Not Applicable |
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#59 Title IV-E (Foster Care) |
Condition Applies |
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#60 Title IVE (Adoption Subsidy) |
Condition Does Not Apply |
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#61 Title IVA (Aid to Families with Dependent Children) |
Condition Does Not Apply |
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#63 Title XIX (Medicaid) |
Condition Applies |
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#64 SSI or other Social Security Act Benefits |
Condition Applies |
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#65 None of the Above |
Condition Does Not Apply |
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#66 Amount of monthly foster care payment (regardless of source) |
0435 |
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Attachments:
State Guide to an AFCARS Assessment Review HTML or PDF(332 KB)